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The research is the biggest study of its kind to investigate the idea that the timing of drugs affects health outcomes

The researchers said that the project includes a total of 292 doctors trained in ambulatory blood pressure monitoring, which involves patients wearing a special cuff that records blood pressure at regular intervals throughout the day and night.

Compared to those who took their medicine in the morning, the people who took their medicine at night had almost half the risk of dying from heart problems and almost half the risk of having heart attack, stroke, heart failure, myocardial infarction or of needing a procedure to unblock their arteries. Heart failure risk went down 42% and coronary revascularisation by 40%.

Author Professor Ramon Hermida said: "Current guidelines on the treatment of hypertension do not mention or recommend any preferred treatment time". Hermidia said that the average blood pressure levels while asleep, and the dipping night-time blood pressure - but not day-time blood pressure measured in the clinic - are jointly two of the most significant markers of cardiovascular risk.

In the largest ever study conducted of the kind, researchers have found that patients who took their blood pressure reducing medication in one go just before bedtime had almost half the risk of dying from or suffering heart attacks, myocardial infarction, stroke, and heart failure compared to patients who took their medication in the morning.

This latest trial is the largest so far to look at the phenomenon with high blood pressure pills, and included more than 19,000 people on these medications. The first were told to take all their hypertension drugs at bedtime, while the second were instructed to have the medication upon waking.

The research team studied all the patients for a duration of long six years. The patients' blood pressure was checked over 48 hours at least once a year.

Results, published in the European Heart Journal, show taking hypertension pills at bedtime reduced the participants' risk of death caused by heart disease. Coronary revascularisation is surgery to widen narrowed or blocked arteries.

The findings held true even when factors likely to influence the results were taken into account, such as cholesterol levels and gender, and whether people smoked or had Type 2 diabetes.

Patients in the study who took their medication at bedtime had significantly lower average blood pressure both at night and during the day, and their blood pressure dipped more at night, when compared with patients taking their medication each morning.

There are no studies showing that treating hypertension in the morning improves the reduction in the risk of cardiovascular disease, he said.

Dr Paul Leeson, professor of cardiovascular medicine at the University of Oxford, said: "This study has the potential to transform how we prescribe blood pressure medication".

"The scale of the project, length of follow up and size of effect are impressive".

"If you're now taking blood pressure medication, it's important to check with your GP or pharmacist before changing the time you take it". Are side effects less problematic at night? The blood pressure decreased by 10 to 20 percent by taking the medicines at night.

The scientists stress the participants all slept at night time, therefore it is unclear if the same results would occur among shift workers.

More research will need to be done to see if the results can be replicated in other ethnic groups.

The team are looking into the "ideal" blood pressure readings during sleep to reduce a patient's heart disease risk.

Vanessa Smith, senior cardiac nurse at the British Heart Foundation (BHF), said the study supported previous evidence but further research was needed.

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